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Heller myotomy

Helle Ø Kristensen, Jakob Kirkegård, Daniel Willy Kjær, Frank Viborg Mortensen, Rastislav Kunda, Niels Christian Bjerregaard
BACKGROUND: Peroral endoscopic myotomy (POEM) is an emerging procedure in the treatment of esophageal achalasia, a primary motility disorder. However, the long-term outcome of POEM in patients, who have previously undergone a Heller myotomy, is unknown. METHODS: Using a local database, we identified patients with esophageal achalasia, who underwent POEM. We compared patients with a previous Heller myotomy to those, who had received none or only non-surgical therapy prior to the POEM procedure...
October 3, 2016: Surgical Endoscopy
Mario Masrur, Luis Fernando Gonzalez-Ciccarelli, Pier C Giulianotti
No abstract text is available yet for this article.
August 4, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Renato Salvador, Lorenzo Spadotto, Giovanni Capovilla, Guerrino Voltarel, Elisa Pesenti, Cristina Longo, Francesco Cavallin, Loredana Nicoletti, Alberto Ruol, Michele Valmasoni, Stefano Merigliano, Mario Costantini
BACKGROUND: The aims of the study were (a) to examine the final outcome in patients experiencing accidental mucosal perforation during laparoscopic Heller myotomy with Dor fundoplication (LHD) and (b) to evaluate whether perforation episodes might influence the way in which surgeons subsequently approached the LHD procedure. METHODS: We studied all consecutive patients that underwent LHD between 1992 and 2015. Patients were divided into two main groups: those who experienced an intraoperative mucosal perforation (group P) and those whose LHD was uneventful (group NP)...
September 29, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
An Moonen, Guy Boeckxstaens
Achalasia is a primary esophageal motor disorder of the esophagus that is characterized by the absence of esophageal peristalsis and a failure of the lower esophageal sphincter (LES) to relax upon swallowing. The defective relaxation leads to symptoms of dysphagia for solids and liquids, regurgitation, aspiration, chest pain, and weight loss. Achalasia is believed to result from a selective loss of enteric inhibitory neurons, most likely due to an autoimmune phenomenon in genetic susceptible individuals. As there is no curative treatment for achalasia, treatment is confined to disruption of the LES to improve bolus passage...
September 29, 2016: Current Treatment Options in Gastroenterology
Oscar M Crespin, Louis W C Liu, Ambica Parmar, Timothy D Jackson, Jemila Hamid, Eran Shlomovitz, Allan Okrainec
INTRODUCTION: Peroral endoscopic myotomy (POEM) is a novel intervention for the treatment of achalasia, which combines the advantages of endoscopic access and myotomy. The purpose of this study was to perform a systematic review of the literature to evaluate the efficacy and safety of POEM. METHODS: The systematic review was conducted following the PRISMA guidelines. Evidence-Based Medicine Reviews, Cochrane Central Register of Controlled Trials, Ovid MEDLINE (R) including in-process and non-indexed citations were searched for POEM studies using the keywords: esophageal achalasia, POEM, endoscopy, natural orifice surgery, laparoscopic Heller myotomy (LHM), and related terms...
September 15, 2016: Surgical Endoscopy
Stavros N Stavropoulos, David Friedel, Rani Modayil, Henry P Parkman
Achalasia is a rare esophageal motility disorder that is usually idiopathic in origin. It is characterized by dysphagia, and patients often have chest pain, regurgitation, weight loss, and an abnormal barium radiograph showing esophageal dilation with narrowing at the gastroesophageal junction. Abnormal or absent esophageal peristalsis and impaired relaxation of the lower esophageal sphincter (LES) are typically seen on esophageal manometry. The advent of high resolution manometry (HRM) has allowed more precise diagnosis of achalasia, subtype designation, and differentiation from other esophageal motor disorders with an initial seminal publication in 2008 followed by further refinements of what has been termed the Chicago classification...
2016: BMJ: British Medical Journal
Caitlin C Chrystoja, Gail E Darling, Nicholas E Diamant, Paul P Kortan, George A Tomlinson, Wayne Deitel, Audrey Laporte, Julie Takata, David R Urbach
OBJECTIVES: Achalasia is a chronic, progressive, and incurable esophageal motility disease. There is clinical uncertainty about which treatment should be recommended as first-line therapy. Our objective was to evaluate the effectiveness of pneumatic dilation compared with laparoscopic Heller myotomy with partial fundoplication in improving achalasia-specific quality of life. METHODS: This was a prospective, multicenter, randomized trial at five academic hospitals in Canada...
September 13, 2016: American Journal of Gastroenterology
Ciro Andolfi, P Marco Fisichella
Surgical correction of achalasia using laparoscopic Heller myotomy with Dor fundoplication is argued to be the gold standard treatment for patients with achalasia. The goal of this technical report is to illustrate our preferred approach to patients with achalasia and to provide the reader with a detailed description of our operative technique, its rationale, and our pre and postoperative management.
September 8, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Stavros N Stavropoulos, Rani Modayil, David Friedel
Per-oral endoscopic myotomy has emerged as the preferred option for treatment of achalasia. This entirely endoscopic procedure has clinical efficacy and lower esophageal sphincter disruption comparable to laparoscopic Heller myotomy with lesser postprocedure pain and length of stay. This review describes per-oral endoscopic myotomy technique, evolution, patient selection, comparison to other therapies, training, and future considerations, including extrapolation of tunnel endoscopy to other situations.
2016: Seminars in Thoracic and Cardiovascular Surgery
Mridul Dhar, Nimisha Verma, Ram Badan Singh, Vishal Krishna Pai
INTRODUCTION: Allgrove syndrome (AS) is a rare autosomal recessive disorder characterized by achalasia cardia, alacrimia, and adrenocorticotropic hormone-resistant adrenal insufficiency which is sometimes associated with autonomic dysfunction. It has also been referred to as the triple A syndrome in view of the cardinal symptoms described above. First described by Allgrove et al in 1978, the disorder usually presents mostly during the first decade of life. These patients have the threat of adrenal crisis, shock, and hypoglycemia and are usually on steroid supplementation...
September 2016: Journal of Clinical Anesthesia
Heidi J Miller, Ruel Neupane, Mojtaba Fayezizadeh, Arnab Majumder, Jeffrey M Marks
BACKGROUND: Achalasia is a rare motility disorder of the esophagus. Treatment is palliative with the goal of symptom remission and slowing the progression of the disease. Treatment options include per oral endoscopic myotomy (POEM), laparoscopic Heller myotomy (LM) and endoscopic treatments such as pneumatic dilation (PD) and botulinum toxin type A injections (BI). We evaluate the economics and cost-effectiveness of treating achalasia. METHODS: We performed cost analysis for POEM, LM, PD and BI at our institution from 2011 to 2015...
August 17, 2016: Surgical Endoscopy
Whitney D Johnson, M Blair Marshall
Patients with previous foregut surgery who develop additional foregut pathology can be a challenge. Those who have formerly undergone gastric bypass and later develop achalasia are at increased risk related to previous surgery. In this case report, we describe an alternative approach for the Dor fundoplication after laparoscopic Heller myotomy in the setting of the altered anatomy. The technique and advantages of this approach are detailed in the discussion of this patient.
May 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Andreas M Schneider, Brian E Louie, Heather F Warren, Alexander S Farivar, Drew B Schembre, Ralph W Aye
BACKGROUND: Per oral endoscopic myotomy (POEM) is increasingly utilized to treat patients with achalasia. Early results have demonstrated significant improvement of symptoms, but there are concerns about postoperative reflux. With only limited comparative data available, we sought to compare POEM to laparoscopic Heller myotomy (LHM) with partial fundoplication. METHODS: This is a retrospective review of 42 POEM and 84 LHM patients undergoing primary myotomy for achalasia...
August 11, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Eric S Hungness, Joel M Sternbach, Ezra N Teitelbaum, Peter J Kahrilas, John E Pandolfino, Nathaniel J Soper
OBJECTIVE: We aimed to report long-term outcomes for patients undergoing per-oral endoscopic myotomy (POEM) after our initial 15-case learning curve. BACKGROUND: POEM has become an established, natural-orifice surgical approach for treating esophageal motility disorders. To date, published outcomes and comparative-effectiveness studies have included patients from the early POEM experience. METHODS: Consecutive patients undergoing POEM after our initial 15 cases, with a minimum of 1-year postoperative follow-up, were included...
September 2016: Annals of Surgery
Yoshihito Souma, Kiyokazu Nakajima, Eiji Taniguchi, Tsuyoshi Takahashi, Yukinori Kurokawa, Makoto Yamasaki, Yasuhiro Miyazaki, Tomoki Makino, Tetsuhiro Hamada, Jun Yasuda, Takeyoshi Yumiba, Shuichi Ohashi, Shuji Takiguchi, Masaki Mori, Yuichiro Doki
BACKGROUND: Controversy remains whether preoperative pneumatic balloon dilation (PBD) influences the surgical outcome of laparoscopic esophagocardiomyotomy in patients with esophageal achalasia. The aim of this study was to evaluate whether preoperative PBD represents a risk factor for surgical complications and affects the symptomatic and/or functional outcomes of laparoscopic Heller myotomy with Dor fundoplication (LHD). METHODS: A retrospective chart review was conducted on a prospectively compiled surgical database of 103 consecutive patients with esophageal achalasia who underwent LHD from November 1994 to September 2014...
August 8, 2016: Surgical Endoscopy
Felice Schnoll-Sussman, Philip O Katz
Esophageal dysphagia in the elderly is a common clinical problem. Achalasia is a disease in which there is loss of ganglion in the myenteric plexus of the lower esophageal sphincter resulting in incomplete relaxation of that muscle causing a functional obstruction to outflow. Treatment is aimed at reducing sphincter pressure allowing for gravity and the oral portion of the swallow to propel the bolus through the esophagus. Pneumatic dilatation, Heller myotomy (laparoscopic), and the newest procedure peroral endoscopic esophageal myotomy (POEM) are all reasonable options for effective treatment even in the elderly...
September 2016: Current Treatment Options in Gastroenterology
Rodolfo J Oviedo, Chase W Sofiak, Bruce M Dixon
INTRODUCTION: Achalasia is a condition that occurs when the lower esophageal sphincter (LES) fails to properly relax, combined with slowing/failure of esophageal peristalsis. This is seen clinically by not allowing solids and liquids to pass easily into the stomach. Achalasia is not historically associated with morbid obesity, yet dual treatment of morbid obesity and achalasia is becoming more prominent due to the worldwide obesity epidemic. PRESENTATION OF CASE: Achalasia is typically a disease that affects non-obese adults over the age of 55, which makes the discussion of this case report unique in that our patient is a 23 year-old woman who successfully underwent per-oral endoscopic myotomy (POEM) in preparation for a future laparoscopic sleeve gastrectomy...
2016: International Journal of Surgery Case Reports
Anell Meyer, Anthony Catto-Smith, Joe Crameri, Di Simpson, George Alex, Winita Hardikar, Donald Cameron, Mark Oliver
BACKGROUND: Oesophageal achalasia is well-recognized but relatively rare in children, occasionally appearing as the "triple A" syndrome (with adrenal insufficiency and alacrima). Treatment modalities, as in adult practice, are not curative, often needing further interventions and spurring the search for better management. The outcome for syndromic variants is unknown. We sought to define the efficacy of treatments for children with achalasia with and without triple A syndrome. METHODS: We conducted a retrospective analysis of presentation and outcomes for 42 children with achalasia presenting over 3 decades to a major paediatric referral centre...
July 13, 2016: Journal of Gastroenterology and Hepatology
C M G Saleh, F A M Ponds, M P Schijven, A J P M Smout, A J Bredenoord
BACKGROUND: Heller myotomy is an effective treatment for the majority of achalasia patients. However, a small proportion of patients suffer from persistent or recurrent symptoms after surgery and they are usually subsequently treated with pneumodilation (PD). Data on the efficacy of PD as secondary treatment for achalasia are scarce. Therefore, this study aimed to investigate the efficacy of PD as treatment for achalasia patients suffering from persistent or recurrent symptoms after Heller myotomy...
July 11, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Basak Erginel, Feryal Gun Soysal, Erbug Keskin, Alaaddin Celik, Tansu Salman
Introduction The aim of this study was to review a single institution's experience with surgical interventions in children with achalasia and to determine treatment strategies for this rare disorder. Patients and methods This study is a retrospective analysis of 22 cases of childhood achalasia from 1991 to 2013. The patients were evaluated in terms of age, symptoms, interventions, intraoperative complications, and recurrent dysphagia. Results There were 13 boys and nine girls (7 months to 17 years old). The clinical symptoms were vomiting (68%), dysphagia (36%), wheezing (18%), coughing (13%), and weight-loss (13%)...
February 2016: Acta Chirurgica Belgica
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